Birth Prevalence of Congenital Cytomegalovirus Infection in HIV-Exposed Uninfected Children in the Era of Combination Antiretroviral Therapy

Abstract

Objectives-To estimate birth prevalence of congenital cytomegalovirus (cCMV) in HIVexposed uninfected children born in the current era of combination antiretroviral therapy and describe cCMV-related neurodevelopmental and hearing outcomes.Study design-The Surveillance Monitoring for ART Toxicities cohort study follows HIVexposed uninfected children at 22 sites in the US and Puerto Rico. Birth cCMV prevalence was estimated in a subset of participants who had blood pellets collected within three weeks of birth and underwent ≥1 of 6 assessments evaluating cognitive and language development including an audiologic examination between 1 and 5 years of age. Detection of CMV DNA by polymerase chain reaction testing of peripheral blood mononuclear cells was used to diagnose cCMV. Proportions of suboptimal assessment scores were compared by cCMV status using Fisher exact test.Results-Mothers of 895 eligible HIV-exposed uninfected children delivered between 2007 and 2015. Most (90%) were on combination antiretroviral therapy, 88% had an HIV viral load of ≤400 copies/mL, and 93% had CD4 cell counts of ≥200 cells/μL. Eight infants were diagnosed with cCMV, yielding an estimated prevalence of 0.89% (95% CI, 0.39%−1.75%). After adjusting for a sensitivity of 70%−75% for the testing method, projected prevalence was 1.2%−1.3%. No differences were observed in cognitive, language and hearing assessments by cCMV status.Conclusions-Although birth cCMV prevalence in HIV-exposed uninfected children born to women with well-controlled HIV is trending down compared with earlier combination antiretroviral therapy-era estimates, it is above the 0.4% reported for the general US population. HIV-exposed uninfected children remain at increased risk for cCMV.

Congenital Cytomegalovirus and Human Immunodeficiency Virus: Effects on Hearing, Speech and Language Development, and Clinical Outcomes in Children

“…They found that “cCMV was present in 23.2% of infants with in utero ” HIV infection, suggesting a relatively high rate of CMV infection in HIV-exposed infants. Purswani et al ( 54 ) studied a similar population, except the mothers with HIV were receiving ART. Of 895 mothers with HIV-exposed children, 90% were receiving ART.…”

Cribado de infección por citomegalovirus congénito en recién nacidos de alto riesgo

“…La mujer gestante portadora de VIH tiene mayor riesgo de infección no primaria de CMV durante el embarazo por lo que el hijo de madre con esta infección se ha considerado como de riesgo para la infección congénita por CMV. La prevalencia en nuestro estudio fue de 4,9%, que concuerda con lo reportado en la literatura médica (2-7%) 20,[40][41][42] , si bien la incidencia ha ido disminuyendo con la terapia anti-retroviral (TARV) efectiva en los últimos años 43,44 . En Chile, se realiza el estudio de CMV en orina en forma rutinaria a todos los hijos de madre portadora de VIH 20 .…”

Recomendaciones para el diagnóstico y el manejo de la infección por citomegalovirus en la mujer embarazada y el recién nacido

“…La prevalencia de CMVc varía entre el 4% y el 26% en los RN con infección por VIH y entre el 1,2% y el 5% en aquellos expuestos al VIH pero no infectados 103,106,107 . Si bien la incidencia ha ido disminuyendo en los últimos años gracias a la terapia antirretroviral efectiva 108,109 , el principal factor de riesgo de transmisión es el recuento de linfocitos T-CD4 maternos < 200 céls/ml durante el embarazo (OR: 2.9; IC95%: 1.2-7.3; p = 0,02) 107 atribuibles a esta infección 5 . Se debe recordar que el cribado auditivo solo detecta un 20% a un 60% de las hipoacusias sensorioneurales asociadas a CMVc, debido a que el resto pueden ser de aparición tardía (43%) (v. apartado «Cribado en el recién nacido») [110][111][112] .…”